| NPI | 1457391310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA09827200) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 043579) |
| 2084P0805X (Licence: CT 043579) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2021-08-05 |