| NPI | 1588670699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 25775) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 131967) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2024-05-18 |