| NPI | 1902395536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA MD468860) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2019-11-08 |