| NPI | 1790076321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA MD.206123) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: LA MD.206123) |
| Enumeration Date | 2011-04-30 |
| Last Update Date | 2026-04-08 |