| NPI | 1194787200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX M9527) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TX M9527) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: TX M9527) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2022-11-22 |