| NPI | 1538324132 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: MO 2015029587) | 
| Additional Taxonomies | 2084N0600X (Licence: KS 0438318) | 
| 2084N0600X (Licence: MO 2015029587) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208000000X Pediatrics (Licence: MO 2015029587) | |
| 208000000X Pediatrics (Licence: KS 0438318) | |
| 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: KS 0438318) | |
| Enumeration Date | 2008-07-23 | 
| Last Update Date | 2025-02-03 |