| NPI | 1912981911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 245228-1) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: HI DOS-940) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2018-09-26 |