| NPI | 1740842632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 10145515) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MT219470) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD480122) | |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2023-06-22 |