| NPI | 1386057487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 297415) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA L-259313) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AZ 61163) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME146545) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 269629) | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2021-02-22 |