| NPI | 1255081287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MN 74697) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 32583) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 74697) | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2025-06-19 |