| NPI | 1912095977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00177700) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NJ SI00177700) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2019-11-20 |