| NPI | 1821188905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: GA 052899) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 052899) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: GA 52899) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI MD-17658) | |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: CA C202394) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2026-02-24 |