| NPI | 1912922568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 28245) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NC 224) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NC 2075) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2008-03-12 |