NPI | 1700804796 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 250019) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 226654) |
Enumeration Date | 2006-07-17 |
Last Update Date | 2013-04-11 |