| NPI | 1962931758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 34.016379) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 94-09229) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: LA 323738) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: KY 04740) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: OH 34.016379) | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2023-07-07 |