| NPI | 1417115742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 200000571) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200000571) |
| 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: NC 200000571) | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: NC 200000571) | |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2023-06-01 |