| NPI | 1861477259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH 16646) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH T-0707) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 320000405) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2021-03-18 |