| NPI | 1881094142 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2084N0600X (Licence: OH 57.024022) | 
| Additional Taxonomies | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: ZZ 2028712) | 
| Enumeration Date | 2014-08-23 | 
| Last Update Date | 2014-08-23 |