| NPI | 1982672200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: OH 35.08457) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.084257) |
| Enumeration Date | 2006-03-11 |
| Last Update Date | 2012-12-27 |