NPI | 1679192322 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 328497) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME167030) |
Enumeration Date | 2020-04-13 |
Last Update Date | 2024-06-28 |