| NPI | 1528702362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MB12428300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB12428300) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2026-07-07 |