| NPI | 1609238815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD472717) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 293276) |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: PA MD472717) | |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2021-09-22 |