| NPI | 1922539634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 64165) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 70131-21) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MN 64165) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WI 70131-21) | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2020-08-06 |