| NPI | 1720348592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL ME137148) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 274054) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME137148) | |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2019-12-18 |