| NPI | 1578209482 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: UT 14216362-1205) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-2172) | 
| Enumeration Date | 2022-05-12 | 
| Last Update Date | 2025-06-02 |