| NPI | 1013258631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD60479306) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A124711) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MI 5315234608) | |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2024-11-08 |