| NPI | 1619949526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: ME MD18501) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 222511) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 222511) | |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2018-09-20 |