| NPI | 1104009398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: KY 41658) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: NY 255992) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 41658) | |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2021-06-30 |