| NPI | 1508114810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MN 26124) |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: MN 26124) |
| 2084P0005X Psychiatry & Neurology, Neurodevelopmental Disabilities (Licence: MN 26124) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 26124) | |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2012-08-16 |