| NPI | 1376657940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101250657) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 230381) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 282288) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2019-06-26 |