| NPI | 1679866719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: SC 82275) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 03768) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: KY 03768) | |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2021-05-10 |