| NPI | 1740445691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD439432) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 047178) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 256720) | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2016-09-01 |