| NPI | 1255787487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: OH 35.139078) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MI 4301500842) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.139078) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301500842) | |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2022-08-23 |