| NPI | 1801233945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA A169665) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2020013190) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD15904) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2024-10-29 |