| NPI | 1134625700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 323493) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 22382) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PR 22382) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2023-08-24 |