| NPI | 1467442921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WI 50281) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NE 21748) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NM MD2005-0644) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2018-07-25 |