NPI | 1578558250 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX Q1957) |
Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: IA 34983) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA 34983) | |
Enumeration Date | 2005-09-19 |
Last Update Date | 2024-07-25 |