| NPI | 1497856520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 047027) |
| Additional Taxonomies | 273R00000X Psychiatric Unit (Licence: NY 229479-1) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2014-01-13 |