| NPI | 1629464599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MI 4301503861) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.129184) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301503861) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: OH 35.129184) | |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2024-06-04 |