| NPI | 1811307507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD469935) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 262653) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA M0218005) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2021-07-07 |