| NPI | 1487943114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 052173) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 300674) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042.0013104) | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2019-08-28 |