| NPI | 1710178702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX N5934) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 57.010367) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C175434) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX N5934) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2024-02-12 |