| NPI | 1700011087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 19166) |
| Additional Taxonomies | 2084P0805X (Licence: PR 19166) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 272082) | |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2025-06-18 |