| NPI | 1205956265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: GA 92660) |
| Additional Taxonomies | 2083A0300X Preventive Medicine Addiction Medicine (Licence: NJ 25MA10809300) |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: CO DR.0055465) | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: OH 130525) | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: MO 2022048625) | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: WA MD60562814) | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: IN 01092373A) | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: NJ 25MA10809300) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AZ 14421) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME110716) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2025-01-08 |