| NPI | 1689963241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 131006) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 58343) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G38536) | |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2011-04-05 |