| NPI | 1154687754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA MD.208221) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: LA MD.208221) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2023-08-31 |