| NPI | 1659423291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: OR 13643) |
| Additional Taxonomies | 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: OR 13643) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2016-10-25 |