| NPI | 1164601548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD19249) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 064062) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD442725) | |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2024-08-06 |