| NPI | 1942383450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL ME157788) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: OH 35084081) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.084081) | |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2025-12-05 |