| NPI | 1558583476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.096046) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CO DR.0058073) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2023-03-15 |