| NPI | 1366980088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA12407700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY P05063) |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2025-03-05 |