| NPI | 1295743433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0101035881) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: VA 0101035881) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2009-06-25 |