| NPI | 1043884083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME164065) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 101025) |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2026-07-30 |