| NPI | 1780963835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME158733) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX BP20045231) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: GA 076299) | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2022-11-02 |