| NPI | 1669817250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME145830) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101282928) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT 142589) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 276872) | |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2026-03-25 |