| NPI | 1497727903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD177057) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042.0011077) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 223300) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2016-12-22 |