| NPI | 1316309842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 63539) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: MN 63539) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 69504) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: WI 69504) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2023-04-10 |