| NPI | 1023004603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 216593-1) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 54281) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 216593-1) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: MA 54281) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2011-06-02 |