| NPI | 1124096250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: CA G25102) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: HI MD11763) |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: HI MD11763) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA G25102) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2014-02-06 |