| NPI | 1730286527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL ME 94842) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME 94842) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 24930) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: SC 24930) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2026-01-09 |