| NPI | 1194745257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 150723) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: RI 8850) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-04-23 |