| NPI | 1093192031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 63653) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 298406) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 63353) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2020-04-08 |