| NPI | 1982217063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 35323) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WV 35323) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: LA 336298) | |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2026-01-13 |