| NPI | 1922066620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX F8656) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX F8656) |
| 207RA0401X Internal Medicine Addiction Medicine (Licence: TX F8656) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2022-05-28 |