| NPI | 1104015932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0026528) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: FL 16737) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2019-12-16 |