| NPI | 1225393028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME160711) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DE C1-0029704) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD495889) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101276394) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25IA13150800) | |
| Enumeration Date | 2012-07-08 |
| Last Update Date | 2026-09-03 |