| NPI | 1104822097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX N6128) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: TX N6128) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AR E-1599) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2019-01-24 |