| NPI | 1124608690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA MD484342) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD484342) |
| 208000000X Pediatrics (Licence: WA ML61175174) | |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2024-06-26 |