| NPI | 1770962862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL OS18471) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NY 297717) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NJ 25MB11340100) | |
| 208D00000X General Practice (Licence: FL OS18471) | |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2022-05-11 |