| NPI | 1720081987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME90437) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD424452) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 52255) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 214959) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2022-10-10 |