| NPI | 1174706253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101243101) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 24263) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: VA 0101243101) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 046357) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DE c10008633) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 42986) | |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2024-04-09 |