| NPI | 1760682025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD453800) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DE C1-0011230) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME110059) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2010-00209) | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2024-03-25 |