| NPI | 1720282429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD444596) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101263878) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 270936) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2025-08-15 |