| 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 |