| NPI | 1508909540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: ND 12502) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ND 12502) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX K-6777) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI 12616) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: HI 12616) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX K-6777) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2020-08-21 |