| NPI | 1831352475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX N6260) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX N6260) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2013-05-06 |