| NPI | 1427047513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME134457) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 15075) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 41484) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2021-09-09 |