| NPI | 1326675596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME MD28058) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH 22891) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042.016598) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2025-03-18 |