| NPI | 1033231881 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: AZ R71474)  | 
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 001907)  | 
| Enumeration Date | 2007-04-04 | 
| Last Update Date | 2009-07-31 |