| NPI | 1154360824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MS 17435) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 17435) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2005021711) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2019-02-26 |