| NPI | 1336285261 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 033886) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 179918-1) | 
| 207R00000X Internal Medicine (Licence: GA 033886) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 179918) | |
| Enumeration Date | 2007-01-29 | 
| Last Update Date | 2025-06-02 |