| NPI | 1346259637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 237756) |
| Additional Taxonomies | 251S00000X (Licence: CT 043723) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2012-04-02 |