| NPI | 1336124676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: CT 039392) |
| Additional Taxonomies | 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: CT 039392) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2007-07-08 |