| NPI | 1750448775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: GA 51830) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 051830) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 051830) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2013-12-11 |