| NPI | 1154522696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO 2018010300) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD427511) |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: PA MD427511) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: MO 2018010300) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2024-02-07 |