| NPI | 1164871687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD18164) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME142320) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A-175011) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 312818) | |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2024-10-31 |