| NPI | 1689673253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: ME DO2981) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0102026059) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 118281) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2025-02-20 |