| NPI | 1205147956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME150686) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 272806) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.139845) | |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2026-07-29 |