| NPI | 1144858218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: PA OT023742) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL OS19013) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2024-06-04 |