| NPI | 1669669479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: UT 6681946-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 6681946-1205) |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2024-04-26 |