| NPI | 1700156403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 111860) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 111860) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2023-03-07 |