| NPI | 1639661325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 010213) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: AZ 010213) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2024-11-15 |