| NPI | 1376555276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: MA 77656) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 77656) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2013-04-05 |