| NPI | 1245235753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY MD095182) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY MD095182) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2011-01-14 |