| NPI | 1417014309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: KY 26754) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: IN 01041738) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 26754) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2016-06-30 |