| NPI | 1811018955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 200867) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: LA 200867) |
| 208D00000X General Practice (Licence: LA 200867) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2023-09-18 |