| NPI | 1164596615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 47803-020) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 47803-020) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: WI 47803-20) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2015-11-06 |