| NPI | 1689284002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: NY 324104) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA12637700) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD484047) | |
| Enumeration Date | 2020-08-01 |
| Last Update Date | 2025-10-27 |