| NPI | 1518609940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME169965) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA12977700) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 341674) | |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2026-04-13 |