| NPI | 1104881432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 32763) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 32763) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2022-10-14 |