| NPI | 1538746854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME167276) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2026-04689) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 346803) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 85839) | |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2026-08-26 |