| NPI | 1235203308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MO R1P78) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO R1P78) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA08170700) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-22290) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD431788) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NJ 25MA08170700) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2010-03-03 |