| NPI | 1205052693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA OP60196171) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA 20A23590) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2026-06-08 |