| NPI | 1225071954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME MD30639) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 278932) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX L2482) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2026-08-19 |