| NPI | 1740525765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: MI 4301104715) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2014-07-17 |