| NPI | 1699747758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA MD420275) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD420275) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2013-05-20 |