NPI | 1700811957 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 134889-1) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 47607) |
Enumeration Date | 2006-07-12 |
Last Update Date | 2015-01-14 |