NPI | 1629078373 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT 80222) |
Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD00026193) |
Enumeration Date | 2005-07-22 |
Last Update Date | 2021-03-18 |