| NPI | 1245206606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: MO 2007013167) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2007013167) |
| 363L00000X Nurse Practitioner (Licence: NY 266133) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2023-07-07 |