| NPI | 1316049554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY MD220619) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY MD2206191) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2018-01-04 |