| NPI | 1649244773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME120142) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: WV 16281) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0101280953) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2024-07-09 |