| NPI | 1104403930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 1021411) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 336379-01) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CT 80714) | |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2025-08-26 |