| NPI | 1619356193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 282784) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD16499) |
| 207R00000X Internal Medicine (Licence: RI LP03498) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI LP03498) | |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2026-07-29 |