| NPI | 1871624353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 197546) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME94575) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 64370) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2021-04-06 |