| NPI | 1093395303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME178234) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 340977) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0076030) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 37189) | |
| Enumeration Date | 2021-04-11 |
| Last Update Date | 2026-02-25 |