| NPI | 1184073959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY AL1873620) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 018609) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX E8047) | |
| Enumeration Date | 2016-06-12 |
| Last Update Date | 2016-06-12 |