| NPI | 1659734283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 32204) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: UT 11778298-1205) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2025-06-26 |