| NPI | 1619320025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA10743500) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 303513) | |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2021-02-04 |