| NPI | 1558536425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME109815) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 242406) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD15006) | |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2020-07-06 |