| NPI | 1154463511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: NY 113009) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NY 113009) |
| 208D00000X General Practice (Licence: NY 113009) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2010-10-06 |