| NPI | 1275514713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: VT 042-0011155) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042.0011155) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 290106) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2022-02-01 |