| NPI | 1467526756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: PA MD030827E) |
| Additional Taxonomies | 2084P0805X (Licence: PA MD030827E) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2025-09-11 |