| NPI | 1487634853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: TN MD11931) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: TN MD11931) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2025-09-11 |