NPI | 1518964154 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 0420007975) |
Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: VT 0420007975) |
Enumeration Date | 2005-06-28 |
Last Update Date | 2015-08-19 |