| NPI | 1619173952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A113932) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: CA A113932) |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: OH 35.096856) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2010-0124) | |
| Enumeration Date | 2007-06-24 |
| Last Update Date | 2020-12-15 |