| NPI | 1558821488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME162670) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.150443) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 327891) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2026-01-02 |