NPI | 1053842914 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: UT 12759564-8905) |
Additional Taxonomies | 208000000X Pediatrics (Licence: UT 12759564-1205) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 12759564-1205) | |
Enumeration Date | 2017-03-22 |
Last Update Date | 2024-02-20 |