| NPI | 1023281052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KY 43472) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: GA 061364) |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: KY 42472) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: GA 061364) | |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2022-12-22 |