| NPI | 1083876809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 262429) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DE C7-0003982) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: DE C7-0003982) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2025-12-30 |