| NPI | 1467867929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: CA 154591) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 4301105610) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2022-11-22 |