| NPI | 1972601425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 210815-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 210815-1) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-03-11 |