| NPI | 1215088703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD039498L) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: PA MD039498L) |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: PA MD039498L) | |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2017-01-13 |