| NPI | 1235326513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 264908) |
| Additional Taxonomies | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: NY 264908) |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: VA 0101237455) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101237455) | |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2021-01-14 |