| NPI | 1659424398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 244833) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 244833) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 72661) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2023-07-17 |