| NPI | 1548611494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: UT 13460506-1204) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA OT017118) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2023-08-23 |