| NPI | 1265579585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA G060979) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: ME 013094) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2016-01-21 |