| NPI | 1669683751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME99606) |
| Additional Taxonomies | 174400000X Specialist |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME 99606) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.142024) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL ME99606) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2024-05-06 |