| NPI | 1063400042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0805X (Licence: NY 142753-1) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NY 142753-1) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 142753-1) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2025-09-11 |