| NPI | 1568859635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T1395) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: IL 036.152582) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301114201) | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2023-02-12 |