| NPI | 1851539662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 18588) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 18588) |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2022-07-21 |