| NPI | 1265574479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC 000025782) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0001352) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 216706-1) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-04-30 |