| NPI | 1124134069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 226334) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101289430) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C176067) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA13241100) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2026-08-12 |