| NPI | 1114080215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NJ 25MA04177500) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: NJ 25MA04177500) |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: NJ 25MA04177500) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2013-09-04 |