| NPI | 1164837696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T3100) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: TX T3100) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 78885) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2024-05-21 |