NPI | 1770611717 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 25953) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 155366-1) |
Enumeration Date | 2007-03-01 |
Last Update Date | 2022-12-06 |