| NPI | 1154303618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0101-226458) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: VA 0101-226458) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2011-08-12 |