| NPI | 1508841123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084F0202X Psychiatry & Neurology Forensic Psychiatry (Licence: TX K7081) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology Forensic Psychiatry (Licence: RI MD08849) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: RI MD08849) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: RI MD08849) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX K7081) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: TX K7081) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2013-10-10 |