| NPI | 1962841700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: SC 35866) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 35866) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC MD35866) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2022-10-04 |