| NPI | 1245279017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 101543-1) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G17712) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME15636) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 78302) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2007-07-08 |