| NPI | 1457413171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 266321) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD12490) |
| Enumeration Date | 2006-12-16 |
| Last Update Date | 2016-07-25 |