| NPI | 1013067388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CT 051741) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD-056667L) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 165618) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2024-01-08 |