| NPI | 1679070650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: TX U2773) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX U2773) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2023-07-06 |