| NPI | 1588747919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 22714) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: KY 22714) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: KY 22714) | |
| 2084P0805X (Licence: KY 22714) | |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2025-02-19 |