| NPI | 1245684075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 288343) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT MED-PHYS-LIC-88129) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 172135) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2021-0207) | |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2023-08-22 |