| NPI | 1336318245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: FL ME86644) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 058801) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 432303) | |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2008-02-25 |