| NPI | 1568667251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX N8674) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301093993) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MI 4301093993) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX N8674) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2011-07-15 |