| NPI | 1154732592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 307208) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OT015955) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH 21155) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OS018887) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2018-00408) | |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2021-03-04 |