| NPI | 1003161522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 147068) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 83602) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301500270) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 284736) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2019-01992) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 58724) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2019-0769) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD193268) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: CA 147068) | |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2020-07-15 |