| NPI | 1689883456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NM A-1574-10) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM A-1574-10) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NM A-1574-10) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2026-07-21 |