| NPI | 1669569216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CT 036852) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 204449) |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: NY 204449) | |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: CT 036852) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2016-09-07 |