| NPI | 1215941000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NJ 25MA04236100) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NJ 25MA04236100) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2014-03-10 |