| NPI | 1508075698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2017038662) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MO 2017038662) |
| 208000000X Pediatrics (Licence: MO 2017038662) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI 13463) | |
| 208000000X Pediatrics (Licence: HI 13463) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: HI 13463) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2025-09-15 |