| NPI | 1033643960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: KY 57492) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 315847) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 57492) | |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2025-06-18 |