| NPI | 1649878604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 79426) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY P105264) |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2024-10-01 |