| NPI | 1609801059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 253743) |
| Additional Taxonomies | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: NY 253743) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C140741) | |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: CA C140741) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2016-12-11 |