| NPI | 1922267632 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101277729)  | 
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: NY 261808)  | 
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 261808)  | |
| Enumeration Date | 2008-06-06 | 
| Last Update Date | 2024-06-27 |