| NPI | 1982996484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME165024) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA09383700) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 279903) | |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2024-01-12 |