| NPI | 1174542963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D59971) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DC 035858) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2019-12-18 |