| NPI | 1174604532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 031512) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 106389) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME83902) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2007-07-08 |