| NPI | 1023513249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: WI 81542) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: IL 18-52340) |
| 208D00000X General Practice (Licence: WI 81542-21) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2024-10-24 |