| NPI | 1760700603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology Neurology with Special Qualifications in Child Neurology (Licence: GA 70448) |
| Additional Taxonomies | 2084N0402X Psychiatry & Neurology Neurology with Special Qualifications in Child Neurology (Licence: WI 54856-020) |
| 208000000X Pediatrics (Licence: CT 047999) | |
| Enumeration Date | 2010-05-16 |
| Last Update Date | 2013-08-22 |