PND - Pediatric Neurotransmitter Disease

Registry for Medical Professionals

Health Care Provider

First Name:
Last Name:
Hospital, Clinic or University
Address
City ,		State
Zip Code
Country
Work Phone	Fax	E-Mail Address

Professional Certifications

MD		RN
PhD		Therapist
FACMG		LPN
MSN		Other(Specify)

Practice Specialty

Pediatrics		Speech Therapy
Neurology		Physical Therapy
Genetics		Occupational Therapy
Family Practice		Other(Specify)

PND Patient Population

Tyrosine Hydroxylase Deficiency
Aromatic L-Amino Acid Decarboxylase Deficiency
GTP Cyclohydrolase I Deficiency(Dopa Responsive Dystonia)
Succinic Semialdehyde Dehydrogenase Deficiency(SSADH)

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