| NPI | 1669217469 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: IA R-11310)  | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-11310)  | 
| Enumeration Date | 2024-06-25 | 
| Last Update Date | 2024-06-25 |