| NPI | 1790837490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD044333L) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: PA MD044363L) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2014-01-16 |