| NPI | 1235103375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 44808) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 33832) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH 3655) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2021-05-26 |