| NPI | 1376580605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 226728) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME98036) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 039905) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2019-04-12 |