| NPI | 1114122595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD13763) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301506255) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 56760) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT 128617) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2025-05-29 |