| NPI | 1124048392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: OH 35.055957) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.055957) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2015-07-29 |