| NPI | 1023151537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 4098) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: AZ 4098) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: CA 20A10101) | |
| 2084P0805X (Licence: AZ 4098) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2020-10-07 |