| NPI | 1730448150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101268703) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101268703) |
| 208000000X Pediatrics (Licence: DC MD042964) | |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2021-07-16 |