| NPI | 1245989458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: RI MD18063) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL 165538) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2024-07-05 |