| NPI | 1164558151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MN 56902) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SD #5696) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 56902) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2020-07-10 |