| NPI | 1922010735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 247700) |
| Additional Taxonomies | 2084P0805X (Licence: NY P 49357) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2019-04-01 |