| NPI | 1437150596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD053658L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD053658L) |
| 208000000X Pediatrics (Licence: NC 2013-02294) | |
| 208000000X Pediatrics (Licence: NY 198984) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 11658) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA MD053658L) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2023-04-12 |