| NPI | 1962609875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME129726) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 51481) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2011-00730) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2024-10-17 |