| NPI | 1730542812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME151773) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX T3493) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2020-03532) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD476265) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 21888) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2021046716) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MT 100291) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2024-04-05 |