| NPI | 1609915644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: ID M14379) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2007-0181) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61068068) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NM MD2007-0181) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD61068068) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-05-08 |