| NPI | 1619900198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 73133) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 73133) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: MA 73133) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2011-12-20 |