| NPI | 1619968807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: NY 227452) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 227452) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2022-01-06 |