| NPI | 1740421502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WI 25615-020) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: WI 25615-020) |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: WI 25615-020) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 25615-020) | |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2009-03-09 |