| NPI | 1982814158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 255670) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 225256) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2011-02-28 |