| NPI | 1487638268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084E0001X (Licence: NJ 25MA06794000) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NJ 25MA06794000) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2024-01-19 |