| NPI | 1770876922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 288852) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 288852) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI MD14779) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD14779) | |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2020-01-10 |