| NPI | 1043308760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: CT 036772) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: CT 036772) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CT 036772) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2013-07-03 |