| NPI | 1093873499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 138784) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 138784-1) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA08650200) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2011-11-10 |