| NPI | 1093801789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 195696) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 195696) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2010-08-06 |