| NPI | 1285689901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 63447) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD067006L) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME104919) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2021-11-15 |