| NPI | 1760827778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME147343) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MT 89401) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NJ 25MA10295200) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2021011430) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD476133) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX T3933) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 21752) | |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2024-04-05 |