| NPI | 1881057198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 292083) |
| Additional Taxonomies | 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: MA 292083) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2023-05-16 |