| NPI | 1164508149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036054365) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: IL 036.054365) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: IL 036.054365) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: IL 036.054365) | |
| 261QM0801X | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2017-02-28 |