| 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 |