| NPI | 1356786198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: OH 58.030415) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OT015224) |
| 208D00000X General Practice (Licence: PA OS017403) | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2018-06-27 |