| NPI | 1164465357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: CA G25548) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: CA G25548) |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: CA DEAX58196190) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2019-03-04 |