| NPI | 1184812141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: UT 63590491205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 63590491205) |
| 208000000X Pediatrics (Licence: OH 35095704) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: OH 35095704) | |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2021-11-03 |