| NPI | 1174648232 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 46259) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NJ 46259) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NY 156653-1) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 156653-1) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2010-06-16 |