| NPI | 1093754210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 194664-1) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME 95214) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NJ 25MA06686400) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2007-07-08 |