| NPI | 1568956811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 317183) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 317183) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2023-07-22 |