| NPI | 1093781106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: NJ 25 MA07549000) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NJ 25MA07549000) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2007-11-16 |