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 |