| NPI | 1174936504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA OT015801) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA OS018722) |
| 282N00000X General Acute Care Hospital (Licence: PA 1720153968) | |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2019-04-03 |