| NPI | 1447815071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NJ 25MA11597000) |
| Additional Taxonomies | 261QS1000X Clinic/Center Student Health |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2023-01-16 |