| NPI | 1285043778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 291571) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 291571) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MA 291571) | |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2023-07-19 |