| NPI | 1851145106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MN 80442) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 34212) |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2025-07-24 |