| NPI | 1255537551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 244238) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NY 244238) |
| Enumeration Date | 2007-06-23 |
| Last Update Date | 2023-07-24 |