| NPI | 1740578483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2015-00538) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD458395) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 266638) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT199936) | |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2018-07-25 |