| NPI | 1154374544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 50663) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 174464) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME MD27645) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2023-11-07 |