| NPI | 1023096054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101255019) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: KY 28200) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2014-01019) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 28200) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: KY 28200) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2018-08-06 |