| NPI | 1285262295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME165928) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 59808) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 331606) | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2024-10-28 |