| NPI | 1952415119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 11014) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH11014) |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: FL ME24611) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL ME24611) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME24611) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL ME24611) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2021-03-29 |