| NPI | 1134640337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 325855) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 64570) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 28769) | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2023-11-13 |