| NPI | 1407856057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 30979) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 30979) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 01063008A) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: KY 30979) | |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2026-07-07 |