| NPI | 1366544439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME77043) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD04782) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 52161) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2013-04-25 |