| NPI | 1235217811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301094947) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301094947) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MI 4301094947) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A64575) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2014-01-31 |