| NPI | 1750558979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 258294) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 069167) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: GA 069167) | |
| 283Q00000X Psychiatric Hospital | |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2020-10-22 |