| NPI | 1821403346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: LA 307821) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 307821) |
| 2080H0002X (Licence: LA 307821) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2019-01-19 |