| NPI | 1124315411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2016-02060) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 5026) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2018-12-20 |