| NPI | 1699840314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 213527) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ NJ25MA07685700) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2007-07-09 |