| NPI | 1164541439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0805X (Licence: OR MD25888) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA 00023577) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2023-11-27 |