| NPI | 1023052826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 161660-1 Expired) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI MD-6076) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME 82443) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2007-07-08 |