| NPI | 1497377162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 325800) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME0164412) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA122275100) | |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2024-10-01 |