| NPI | 1073797064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 253669-1) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 253669) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 059164) | |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2021-11-12 |