| NPI | 1831395300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C164012) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NJ 25MA0826900) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 54013020) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 295171) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2024-09-30 |