| NPI | 1699858811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: WI 37852) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 37852) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2016-04-21 |