| NPI | 1174676274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 295363) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD456309) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0059516) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2023-01-31 |