| NPI | 1922190784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 176951) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD044058L) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD044058) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD-044058-L) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2023-05-02 |