| NPI | 1184057648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: TX S2743) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 260723) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX S2743) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A149871) | |
| 208D00000X General Practice (Licence: PR 29472) | |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2023-11-17 |