| NPI | 1700236049 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: AK 225500)  | 
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI MD-21956)  | 
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC LL39543)  | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 39543)  | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A174699)  | |
| Enumeration Date | 2016-06-17 | 
| Last Update Date | 2024-08-08 |