| NPI | 1528406196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 269936) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: RI LP02933) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2017-08-25 |