| NPI | 1609040641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 274155) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NJ 25MA11354500) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 003011) | |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2022-05-27 |