| NPI | 1134623804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WI 73098) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 73098) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2026-04445) | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2026-08-20 |