| NPI | 1881128320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME151830) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL P620800883740) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2021-08-20 |