| NPI | 1063514040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MO 2021026022) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: KS 04-23442) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX U5039) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-23442) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2026-05-13 |