| NPI | 1720040728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: RI MD08308) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: RI MD08308) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2025-10-04 |