| NPI | 1841645223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: CA FC0669739) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: CT 75354) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 295971) | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2026-05-30 |