| NPI | 1811346752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: IA MD-48596) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: KY TP517) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: KY 58316) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 58316) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA MD-48596) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY TP517) | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2025-03-05 |