| NPI | 1073076147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 011418) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 322928) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2024-01834) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: AZ 011418) | |
| Enumeration Date | 2019-04-07 |
| Last Update Date | 2025-02-05 |