| NPI | 1831197250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 60162) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: KY 60162) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA C53946) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C53946) | |
| Enumeration Date | 2005-07-09 |
| Last Update Date | 2025-12-18 |