| NPI | 1366464133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 82593) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 79115) |
| 2084P0805X (Licence: MA 79115) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2025-08-14 |