| NPI | 1962793521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: NJ 25MA10493600) |
| Additional Taxonomies | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: MI 4301109182) |
| 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: NJ 25MA10493600) | |
| 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: MI 4301109182) | |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2019-07-22 |