| NPI | 1962578047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 33595) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NC 33595) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NC 33595) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2021-10-06 |