| NPI | 1912392408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: UT 14212886-1204) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 14212886-1204) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2025-05-07 |