| NPI | 1770013559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MI 5101026596) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5101023239) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5151009728) | |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2022-07-21 |