| NPI | 1013355627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 277559) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI MD-17973) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME MD21386) | |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2022-02-15 |