| NPI | 1770534380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD072088L) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY MD291891) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 291891) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2023-06-30 |