| NPI | 1376585091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 1014448) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 232261) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 042079) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2024-09-03 |