| NPI | 1821388075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX R5037) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R5037) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: TX R5037) | |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2022-04-19 |