| NPI | 1790927929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084B0002X Psychiatry & Neurology, Bariatric Medicine (Licence: NY 112345-1) |
| Additional Taxonomies | 2084B0002X Psychiatry & Neurology, Bariatric Medicine (Licence: CT 017358) |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2009-04-02 |