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 |