| NPI | 1770989469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 282053) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 282053) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA10415400) | |
| Enumeration Date | 2014-11-07 |
| Last Update Date | 2019-12-12 |