| NPI | 1750338497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD09944) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 025766) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G51088) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 74870) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2020-10-13 |