| NPI | 1497250062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY R4747) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY R4747) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2020-10-14 |