| NPI | 1265839054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 289941) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 00000000000) |
| Enumeration Date | 2014-11-23 |
| Last Update Date | 2021-01-13 |