| NPI | 1669457677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101226833) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX R6442) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AK 166864) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: OR MD187125) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 63624) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 115-320) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2018032731) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60850087) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C172244) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2024-08-01 |