| NPI | 1104952373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD432801) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 226027) |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: NY 226027) | |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: PA MD432801) | |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2012-01-05 |