| NPI | 1417391251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: VT 032.0133809) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 277397) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 032.0133809) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 277397) | |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2018-07-23 |