| NPI | 1669496535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR DO185586) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 239696) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MB08215200) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2021-12-09 |