| NPI | 1730220971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: UT 338570-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 338570-1205) |
| 208000000X Pediatrics (Licence: OK 25568) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 338570-1205) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 25568) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2020-12-03 |