| NPI | 1013960566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 156677) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 90543) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA 27755) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2025-05-06 |