| NPI | 1508068081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA MD443889) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036-116935) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2007015932) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MO 2007015932) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2017-01-09 |