| NPI | 1184631384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 42559) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD011481) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: RI MD011481) | |
| 208600000X Surgery (Licence: CT 42559) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-02-03 |