| NPI | 1598714362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: IA 37180) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 48754) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA 37180) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX P8257) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX P8257) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA A122312) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A122312) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2023-03-07 |