| NPI | 1366490195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0805X (Licence: NY 204047) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME140892) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2024-03-05 |