NPI | 1063621696 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301086426) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.093668) |
2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: MI 4301086426) | |
Enumeration Date | 2007-05-21 |
Last Update Date | 2023-06-27 |