| NPI | 1275974941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: TX H3353) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX H3353) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2015-03-26 |