| NPI | 1104132190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 132990) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 132990) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NY 132990) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NY 132990) | |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: NY 132990) | |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: NY 132990) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NY 132990) | |
| 251B00000X Case Management (Licence: NY 132990) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NY 132990) | |
| 282N00000X General Acute Care Hospital (Licence: NY 132990) | |
| 305S00000X Point of Service (Licence: NY 132990) | |
| Enumeration Date | 2010-08-27 |
| Last Update Date | 2010-08-27 |