| NPI | 1255658209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: MA 250619) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 265457) |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2017-08-31 |