| NPI | 1811199763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NC 2008-01569) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: RI MD12349) |
| 208000000X Pediatrics (Licence: NC 2008-01569) | |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2009-01-08 |