| NPI | 1255664769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME144849) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 270357) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2021-03385) | |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2022-02-10 |