| NPI | 1124123930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: VA 0101231294) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0057393) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: DC MD33329) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |