| NPI | 1720182280 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX U0759)  | 
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI 10344)  | 
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: HI 10344)  | |
| Enumeration Date | 2006-09-12 | 
| Last Update Date | 2025-09-26 |