| NPI | 1114128634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WV 25460) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NC 2009-00086) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 25460) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2009-00086) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2015-03-05 |