| NPI | 1174859284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD14356) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C156972) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 1752) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036.130526) | |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2024-02-23 |