| NPI | 1215910914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 54798) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 54798) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2020-12-02 |