| NPI | 1194980979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: GA 07188) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 003460) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2014-12-15 |