| NPI | 1780119446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: PA OS022112) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA OS022112) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT017617) | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2022-06-17 |