| NPI | 1245249978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 206352) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital |
| 282N00000X General Acute Care Hospital (Licence: NY 206352) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2025-11-25 |