| NPI | 1669764627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: MI 4301104329) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-098366) |
| 208000000X Pediatrics (Licence: CA A 74084) | |
| 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: CA A 74084) | |
| 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: OH 35-098366) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MI 4301104329) | |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2019-01-18 |