| NPI | 1669580510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME123802) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 13997) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 49560) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-04-03 |