| NPI | 1063861664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NJ 25BM10446600) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2019-06-24 |