| NPI | 1013081652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 030548) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: GA 030548) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2007-07-08 |