| NPI | 1548360035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 41231) |
| Additional Taxonomies | 2084P0005X Psychiatry & Neurology, Neurodevelopmental Disabilities (Licence: MA 41231) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 41231) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 41231) | |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2013-12-30 |