| NPI | 1417990045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR 165948) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 23771) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CT 047277) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA C55255) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2020-11-09 |