| NPI | 1245664531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME135366) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 18267) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS T-2750) | |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2020-11-02 |