| NPI | 1043659121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD467692) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT202664) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 284982) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2021-02-18 |