| NPI | 1104288406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: MA 291328) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: NY 298743) |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: NJ 25MA11418100) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: CT 61592) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: KY 56096) | |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2024-04-25 |