| NPI | 1194358192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 60238) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 25821) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NV 25821) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: KY 60238) | |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2025-07-18 |