| NPI | 1215319348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301108076) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MN 65512) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MI 5304731992) | |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2022-11-17 |