| NPI | 1801039870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 249796) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital (Licence: NY 249796) |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2013-08-13 |