| NPI | 1972132827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 76849) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 325870) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 325870) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: CT 76849) | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2024-12-17 |