| NPI | 1750801478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 308850) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2019017100) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2017018495) | |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2024-07-23 |