| NPI | 1740579812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 278272) |
| Additional Taxonomies | 2084N0402X Psychiatry & Neurology Neurology with Special Qualifications in Child Neurology (Licence: NY 278272) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2022-08-10 |