| NPI | 1669626081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX Q0849) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 237227) |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2021-09-08 |