| NPI | 1306844691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 195151) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 195151) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2023-07-05 |