| NPI | 1689637621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 173290) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 173290) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2021-10-01 |