| NPI | 1760757017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084E0001X (Licence: NY 292476) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: CT 055545) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 292476) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2024-04-19 |