| NPI | 1104985118 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 72930) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD472572) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 166479-1) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA04760500) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2025-02-19 |