| NPI | 1508246026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 290689) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 61280) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 290689) | |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2021-12-10 |