| NPI | 1508979519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101259575) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 40353) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD453478) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: VA 0101259575) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 76822) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101259575) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C163816) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: PA MD453478) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2024-05-30 |