| NPI | 1235493982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0081151) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA10393000) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2022-06-20 |