| NPI | 1447342449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NY 236622) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 236622) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 236622) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2024-06-12 |