| NPI | 1457406720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 4301082851) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: MI 4301082851) |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: MI 4301082851) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2018-09-28 |