NPI | 1417204819 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: PR 19340) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PR 19340) |
Enumeration Date | 2012-08-06 |
Last Update Date | 2017-12-12 |