| NPI | 1922232644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: OR 161388) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301092871) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MO 2011017914) | |
| Enumeration Date | 2009-05-09 |
| Last Update Date | 2023-11-20 |