| NPI | 1942331400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: WI 60018-20) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 215975) |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: NY 215975) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 60018-20) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2013-05-01 |