| NPI | 1821518051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 287133) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 272193) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2021-06-30 |