| NPI | 1902986771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 178285) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 178285) |
| 208000000X Pediatrics (Licence: NY 178285) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2010-07-07 |