| NPI | 1760867576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NE 30478) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NJ 25MA09675200) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2019-05-31 |