| NPI | 1629636634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY F405538-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 759505) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2024-12-02 |