| NPI | 1386686467 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: MD D44706)  | 
| Additional Taxonomies | 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: PA MD461334)  | 
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MD D44706)  | |
| 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: MN 55982)  | |
| Enumeration Date | 2006-06-12 | 
| Last Update Date | 2020-01-10 |