| NPI | 1396946554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 01012596650) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 218990) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2014-02257) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2021-11-07 |