| NPI | 1770538381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 136559) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ MA04336100) |
| 2084P0805X (Licence: NJ MA04336100) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2024-07-25 |