| NPI | 1851474308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD60171772) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60171772) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2012-04-10 |