| NPI | 1093193120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0008X Psychiatry & Neurology, Neuromuscular Medicine (Licence: NY 309805) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 309805) |
| 208000000X Pediatrics (Licence: MI 4301107318) | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2023-07-07 |