| NPI | 1164099032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 80428) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD482450) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA12826600) | |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2026-08-02 |