| NPI | 1073541892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 20355) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NY 233734) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NY 20355) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2022-12-05 |