| NPI | 1750481727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI 11562) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: WV 20639) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME118107) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: HI 11562) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: HI 11562) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: HI 11562) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2025-02-10 |