| NPI | 1922076819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 180126) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 180126) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2011-06-08 |