| NPI | 1760602650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CT 052883) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 239536) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 239536) | |
| 208000000X Pediatrics (Licence: CT 052883) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2014-07-08 |