| NPI | 1023062783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MN 19808) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 19808) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-03-30 |