| NPI | 1871535534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: MA 277173) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD12140) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 043151) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2020-06-04 |