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 |