NPI | 1518311927 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 301308) |
Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NY 301308) |
Enumeration Date | 2016-04-21 |
Last Update Date | 2025-03-11 |