| NPI | 1689835092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 048560) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 270943) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: CT 048560) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 270943) | |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2013-07-02 |