| NPI | 1619918562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 196574) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD449703) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 033774) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101232103) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2019-07-11 |