| NPI | 1730102310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: CA G76286) |
| Additional Taxonomies | 2084P0005X Psychiatry & Neurology Neurodevelopmental Disabilities (Licence: CA G76286) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2020-01-16 |