| NPI | 1952385130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA OP00002259) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 203646) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ MB08033400) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2007-09-13 |