| NPI | 1073788667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 258356) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301090255) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2013-06-27 |