| NPI | 1700170180 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: FL ME118674) | 
| Additional Taxonomies | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: CA A116424) | 
| 2084N0600X (Licence: CA A116424) | |
| 2084N0600X (Licence: FL ME118674) | |
| Enumeration Date | 2011-06-03 | 
| Last Update Date | 2022-07-14 |