| NPI | 1770733875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: NY 140959) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: NJ 25MA06840100) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2013-05-13 |