| NPI | 1922458611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD214692) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD474975) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME159372) | |
| 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: PA MD474975) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.027713) | |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2023-06-08 |