NPI | 1255664769 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME144849) |
Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: CT 60333) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 270357) | |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2021-03385) | |
Enumeration Date | 2009-09-15 |
Last Update Date | 2024-10-24 |