| NPI | 1649388828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA G53211) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL FL-ME0060288) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G53211) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL ME0060288) | |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2016-01-29 |