| NPI | 1801424478 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA12071600) | 
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 332359) | 
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME169894) | |
| Enumeration Date | 2020-03-30 | 
| Last Update Date | 2025-07-17 |