| NPI | 1528063765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 48123) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MN 48123) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 46660) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2023-05-30 |