| NPI | 1447312814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042.0008042) |
| Additional Taxonomies | 2084P0005X Psychiatry & Neurology, Neurodevelopmental Disabilities (Licence: NH 6027) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2025-06-05 |