| NPI | 1124069372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301113766) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MI 4301113766) |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: MA 150175) | |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: MI 4301113766) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 150175) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2022-07-21 |