| NPI | 1811047996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL me116230) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 183325) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 15284) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 183325) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PR 15284) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL me116230) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2014-01-09 |