| NPI | 1417948795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 28452) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 28452) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2007-07-08 |