| NPI | 1538468707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 268116) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY #390200000x) |
| Enumeration Date | 2011-03-27 |
| Last Update Date | 2019-02-04 |