| NPI | 1871811067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MO 2015022436) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2015022436) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2024-03-07 |