| NPI | 1427674043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME164746) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MD-GTL-20-00805.) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2025-10-10 |