| NPI | 1063400810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WI 63732-20) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 036090712) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2018-03-21 |