| NPI | 1831380856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 288517) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT190960) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2021-11-19 |