| NPI | 1083933212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 55149) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH 16627) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042.0012929) | |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2026-07-21 |