| NPI | 1780658864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA07179100) |
| Additional Taxonomies | 2084P0805X (Licence: NJ 25MA07179100) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2014-08-27 |