| NPI | 1750642179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: PA MD465936) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NJ 25MA10583500) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2025-01-27 |