| NPI | 1154764223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD61479420) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 62857-20) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61479420) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WI 62857-20) | |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2023-09-12 |