| NPI | 1114205390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0015X Psychiatry & Neurology Psychosomatic Medicine (Licence: CO DR.0057182) |
| Additional Taxonomies | 2084P0015X Psychiatry & Neurology Psychosomatic Medicine (Licence: NY 390200000X) |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2016-08-03 |