| NPI | 1457603086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 134691) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 134691) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 134691) | |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2012-10-05 |