| NPI | 1538242094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 041054) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 75045) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CT 041054) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 75045) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2023-04-27 |