| NPI | 1932631751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0090480) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME148281) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A171778) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 309565) | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2022-07-15 |