| NPI | 1114980968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: CT 030847) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 030847) |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: CT 030847) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2013-09-30 |