| NPI | 1811055940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NM MD2023-1273) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: WI AW1297894 XW1297894) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 25744-020) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2024-02-28 |