| NPI | 1124522024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: TX T5203) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: OH 35.142251) |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: FL ME171296) | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: NY 336200) | |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: KY 55382) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2025-07-14 |