| NPI | 1417038001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AK BT7901401) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ MA07600) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: AK XT7901401) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2017-02-16 |