| NPI | 1952628133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 85863) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 270956) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME0142732) | |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2023-03-31 |