| NPI | 1356928360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 1022889) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 75371) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 1022889) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CT 75371) | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2026-05-14 |