| NPI | 1245242601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CT 028721) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 028721) |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: WA 70050328) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2025-11-22 |