| NPI | 1124249735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NH 15847) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 0420012022) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH 15847) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: VT 0420012022) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2024-05-20 |