| NPI | 1912484320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 335536) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME170654) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 22473) | |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2025-07-08 |