| NPI | 1558421016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D17273) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD33212) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2018-10-03 |