| NPI | 1891255857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 81176) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 34.014729) |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2023-07-12 |