| NPI | 1770246928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME174842) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MTL400001290) |
| Enumeration Date | 2021-10-14 |
| Last Update Date | 2025-09-15 |