| NPI | 1003884107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IA 2117) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO R9F15) |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: IA 2117) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-07-08 |