| NPI | 1871858340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: VA 0101280942) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 27410) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.134733) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: OH 35.134733) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WV 27410) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2012017200) | |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2024-08-29 |