| NPI | 1972744712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: KY 03455) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY N/A) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY N/A) | |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2018-09-11 |