| NPI | 1902109150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 302782) |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: NY 302782) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2021-08-20 |