| NPI | 1154426757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX S6743) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101228766) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME143320) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2021-03-09 |