| NPI | 1760570915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: MT MED-PHYS-COM-LIC-173) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 370147-1205) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 370147-1205) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: UT 370147-1205) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2026-07-10 |