| NPI | 1699784561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology Neurology with Special Qualifications in Child Neurology (Licence: WA 14695) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: WA 14695) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2012-11-08 |