| NPI | 1215375969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 276286) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101274129) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX U9849) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA11585500) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD210001647) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL TPME5541) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D92964) | |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2024-07-07 |