| NPI | 1922075589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 133091) |
| Additional Taxonomies | 174400000X Specialist |
| 208000000X Pediatrics (Licence: NY 133091) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2012-01-27 |