| NPI | 1497288682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 306146-01) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 0) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2023-01-24 |