| NPI | 1063477545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MO 2022007260) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 35908KY) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN MD38701) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD60579729) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2022-06-08 |