| NPI | 1477783496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 302150) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 55135) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 55799) | |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2023-10-13 |