| NPI | 1760820948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD479013) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA FP1957705) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 3902000000X) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2024-12-17 |