| NPI | 1811558844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX U8931) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 34723) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036.168499) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: OK 34723) | |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2024-03-20 |