| NPI | 1891787859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 48197) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301058933) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MI 4301058933) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2024-05-17 |