| NPI | 1154506962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA C152747) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C152747) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 245632) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 48256) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: AZ 48256) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 245632) | |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2019-12-13 |