| NPI | 1699807651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 0012388) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A23269) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 250760) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2013-04-02 |