| NPI | 1912128356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 239049) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY 239049) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2014-03-12 |