| NPI | 1689866410 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: DC MD039915) | 
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: DC MD039915) | 
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD039915) | |
| Enumeration Date | 2007-08-15 | 
| Last Update Date | 2012-07-10 |