| NPI | 1679958557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD469594) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 301400) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA11946900) | |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2024-04-30 |