| NPI | 1467984211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD480548) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: VA 0101272464) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 340623) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101272464) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2024-08-02 |