| NPI | 1316258064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA MD458120) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 244761) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD458120) | |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2023-01-04 |