| NPI | 1235227190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 221191) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 221191) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 221191) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME107579) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL ME107579) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2021-09-09 |