| NPI | 1639270218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD042417-L) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH 12678) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0065356) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2007-07-08 |