| NPI | 1801094479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: CT 047643) |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry (Licence: CT 047643) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CT 047643) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2020-10-16 |