| NPI | 1104926310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 47917) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: WI 49717) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2013-03-06 |