| NPI | 1013975945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 041613) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CT 6118715) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2022-04-04 |