| NPI | 1154574176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR C5060) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: AR C5060) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 23832) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: AR C5060) | |
| Enumeration Date | 2008-11-04 |
| Last Update Date | 2009-01-13 |