| NPI | 1841521069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME142436) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101283790) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 274923) | |
| Enumeration Date | 2010-01-28 |
| Last Update Date | 2024-12-02 |