| NPI | 1790796852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D81121) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME101042) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 37770) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2022-02-08 |