| NPI | 1902149958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0008X Pediatrics Neurodevelopmental Disabilities (Licence: OR MD182485) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD182485) |
| 2084N0402X Psychiatry & Neurology Neurology with Special Qualifications in Child Neurology (Licence: OR MD182485) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2021-03-25 |