| NPI | 1780977421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD442119) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 049637.) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 61-003925) | |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2019-10-08 |