| NPI | 1598706988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 248922) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00036796) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042-0009675) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2023-01-21 |