| NPI | 1013478932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MA 292750) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 292750) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 292750) | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2024-06-06 |