| NPI | 1225109390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NJ 25MA06975600) |
| Additional Taxonomies | 273R00000X Psychiatric Unit |
| Enumeration Date | 2006-11-12 |
| Last Update Date | 2014-04-18 |