| NPI | 1649768557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 314753) |
| Additional Taxonomies | 2084H0002X (Licence: NY 314753) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2023-07-21 |