| NPI | 1184924904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: AZ 44538) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 259152) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2014-10-31 |