| NPI | 1366414104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: IA 21876) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NE 15053) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101054894) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: AZ 13743) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2012-04-23 |