| NPI | 1851404545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 263953) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: TX L0011) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: TX L0011) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2023-01-24 |