| NPI | 1972688851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 317765) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NH 20461) |
| 2084S0012X Psychiatry & Neurology, Sleep Medicine (Licence: NH 20461) | |
| 363A00000X Physician Assistant (Licence: NY 011392) | |
| 363A00000X Physician Assistant (Licence: PA MA059191) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2022-07-29 |