| NPI | 1710937636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: KS 04-35111) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: IA 37110) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KS 04-35111) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2011-06-20 |