| NPI | 1326465436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036.161479) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 76824) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA10658500) | |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2023-10-16 |