| NPI | 1437110798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 104193) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO 104193) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2011-05-10 |