| NPI | 1619243193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2022-1124) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NM MD2022-1124) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NM MD2022-1124) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2026-05-29 |