| NPI | 1811064082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NY 220524) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: NY 220524) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: NY 220524) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-07-08 |