| NPI | 1871519215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NJ 25MA08022900) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 249727-1) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2013-10-14 |