| NPI | 1114209301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 54967) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: DE 61-16868) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2025-03-05 |