| NPI | 1598932097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 243541) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 243541) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 243541) | |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2023-02-13 |