| NPI | 1215907506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301029729) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 029729) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2018-02-27 |