| NPI | 1306070115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: KY 59017) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 59017) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2014002057) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MO 2014002057) | |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2024-07-23 |