| NPI | 1043400427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 3683) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 3683) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: AZ 3683) | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2019-09-13 |