| NPI | 1568680973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2009-00456) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP00298) |
| 208000000X Pediatrics (Licence: RI MD12657) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: RI LP00298) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2023-11-01 |