| NPI | 1629274139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: OH 34.009785) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34009785) |
| 207P00000X Emergency Medicine (Licence: MI 5101017440) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OH 34.009785) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2022-11-14 |