| NPI | 1427287994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NC 2017-01481) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101-255657) |
| 208000000X Pediatrics (Licence: MO 2009017502) | |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2017-08-29 |