| NPI | 1174860563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME167530) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 288136) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD184985) | |
| Enumeration Date | 2013-01-06 |
| Last Update Date | 2025-02-12 |