| NPI | 1639365836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NJ 25MA08202700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA08202700) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2021-11-10 |