| NPI | 1407479868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 1021515) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 1021515) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2025-10-29 |