| NPI | 1508981416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 233155) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 233155) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2023-04-20 |