| NPI | 1336260207 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: DC MD037504) | 
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MD D0066737) | 
| Enumeration Date | 2007-04-02 | 
| Last Update Date | 2008-08-05 |