| NPI | 1164533659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 142050) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA03001300) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-11-11 |