| NPI | 1295845485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME122419) |
| Additional Taxonomies | 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: IL 036-069826) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2019-06-28 |