| NPI | 1952808149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: NM DO2023-0179) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: UT 11405456-1204) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2024-08-22 |