| NPI | 1689021875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA MD473488) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A164719) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT219759) | |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2021-08-22 |