| NPI | 1639669997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 312800) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 285681) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.143336) | |
| Enumeration Date | 2018-05-12 |
| Last Update Date | 2023-04-25 |