| NPI | 1336554609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 294236) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IL 125065888) |
| 207R00000X Internal Medicine (Licence: IL 125065888) | |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2018-06-22 |