| NPI | 1699060210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OT014703) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OS017540) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 282241) | |
| Enumeration Date | 2011-06-11 |
| Last Update Date | 2015-11-10 |