NPI | 1801179668 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 268315) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 62436) |
2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL ME115860) | |
Enumeration Date | 2011-09-27 |
Last Update Date | 2019-07-18 |