| NPI | 1740272723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME169348) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: HI 10017) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MS 22206) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2025-02-25 |