| NPI | 1780046813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA A174881) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A174881) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA A174881) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2026-08-19 |