NPI | 1154707057 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: KY 54299) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: KY 54299) | |
Enumeration Date | 2015-08-03 |
Last Update Date | 2021-07-01 |