NPI | 1902071608 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 253776) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 232860) |
Enumeration Date | 2008-04-24 |
Last Update Date | 2021-12-01 |