| NPI | 1730142944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 273R00000X Psychiatric Unit (Licence: TX q8702) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX q8702) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 182242-1) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2023-11-10 |