| NPI | 1578623443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 59300) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX M9561) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NJ 25MA11605600) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2023-05-31 |