NPI | 1306823331 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 9593487-1205) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 34537) |
2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 34537) | |
Enumeration Date | 2005-12-30 |
Last Update Date | 2021-04-05 |