| NPI | 1760459176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 36248) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 36248) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2013-03-07 |