| NPI | 1174733661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 247882-1) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 247882-1) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-01-22 |