| NPI | 1376562298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: PA MD054753L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD054753L) |
| 2084P0005X Psychiatry & Neurology, Neurodevelopmental Disabilities (Licence: PA MD054753L) | |
| 208000000X Pediatrics (Licence: NJ 25MA05790800) | |
| 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: NJ 25MA05790800) | |
| 2084P0005X Psychiatry & Neurology, Neurodevelopmental Disabilities (Licence: NJ 25MA05790800) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2013-04-18 |