| NPI | 1689680514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0067939) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 217337) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 054508) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2011-08-29 |