| NPI | 1174654511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD60218274) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60218274) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60218274) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 35068) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CO 35068) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2011-04-25 |