| NPI | 1629234299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD444351) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT192691) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2015-01-06 |