| NPI | 1104186089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: RI MD15957) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI MD15957) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: RI MD15957) | |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2022-07-21 |