| NPI | 1407206634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 80065) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2016019449) |
| 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: MO 2016019449) | |
| 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: WI 80065) | |
| Enumeration Date | 2016-06-19 |
| Last Update Date | 2022-08-23 |