| NPI | 1760655641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NJ 25MA08359500) |
| Additional Taxonomies | 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: NJ 25MA08359500) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2008-04-10 |