| NPI | 1720191729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A91087) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A91087) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-08-14 |