| NPI | 1174771083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301098102) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MI 4301098102) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A104977) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD196327) | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2021-05-13 |