| NPI | 1073629010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD166198) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: OR MD166198) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60935316) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C161876) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.087693) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2019-10-07 |