| NPI | 1760749600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NM MD2020-0592) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2020-0592) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD458127) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NM MD2020-0592) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: PA MD458127) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA MD458127) | |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2024-02-02 |