| NPI | 1558775148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 61179) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC MD37107) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 319862) | |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2023-04-14 |