| NPI | 1750775664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 73934) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 10092325-1205) |
| 208000000X Pediatrics (Licence: MN 73934) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MN 73934) | |
| Enumeration Date | 2015-03-28 |
| Last Update Date | 2025-11-18 |