| NPI | 1811346752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 58316) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R10567) |
| 207R00000X Internal Medicine (Licence: IA MD-48596) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: KY TP517) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: KY 58316) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA MD-48596) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY TP517) | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2023-10-25 |