| NPI | 1063698330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital (Licence: NY P60621) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ACN1119) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2020-05-20 |