| NPI | 1255495800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME0064606) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 159033) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NJ 49260) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: SC 16673) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2015-02-24 |