| NPI | 1235421157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 273141) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 014489) |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2025-08-22 |