| NPI | 1437636883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 405161) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9190560) |
| 163W00000X Registered Nurse (Licence: NY 805865) | |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2023-07-19 |