| NPI | 1811577414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT233287) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 288903) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD489403) | |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2025-06-02 |