NPI | 1568670461 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 105239) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA PA 30066) |
Enumeration Date | 2007-05-21 |
Last Update Date | 2007-07-08 |