| NPI | 1972765873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: TN 49443) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: KY C2172) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2025-02-27 |