| NPI | 1639512833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX E4613) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101042811) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 168564) | |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2013-04-08 |