| NPI | 1215031661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: RI 08028) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI 08028) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: RI 08028) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2007-07-08 |