| NPI | 1689164105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX U5565) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 314930) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 174290) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: TX U5565) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 1014443) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.143093) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME142986) | |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2025-10-30 |