| NPI | 1417162587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA MD-041265L) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: DE C1-0003764) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2007-07-08 |