| NPI | 1144586777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX 48192) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101265289) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-45903) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: LA 312497) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2024-06-03 |