| NPI | 1245228717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OH OH72394) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: OH 35.072394) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2023-11-27 |