| NPI | 1861121980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA R-12604) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: IA DO-07100) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2026-03-31 |