| NPI | 1255330411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: MD D12564) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: DC 5233) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2024-03-06 |