| NPI | 1811123318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: IA 40363) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA 40363) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA R-8715) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2018-05-15 |