| NPI | 1770933137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 283218) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 267166) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2021-07-27 |