| NPI | 1710938915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 65206-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 185121-1) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2017-10-09 |