| NPI | 1043658305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 333717) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OS024969) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 1025106) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2025-10-11 |