| NPI | 1699747899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2007001624) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301079222) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2010-09-15 |