| NPI | 1972834091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 253470) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 253470) |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2024-06-25 |