| NPI | 1902895857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0805X (Licence: MI 4304043086) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 204082) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2025-09-11 |