| NPI | 1891802666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 159928) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CT 028942) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2014-06-10 |