| NPI | 1720294200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: CT 039073) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: RI MD11169) |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: NY 242647) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: PA MD019895E) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2024-03-20 |