| NPI | 1225444664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology Neurology with Special Qualifications in Child Neurology (Licence: FL ME134715) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2019-07-26 |