| NPI | 1790082543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D80768) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D80768) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: MD D80768) | |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2024-01-17 |