| NPI | 1356340855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WY 2361A) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: WY 2361A) |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: WY 2361A) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2011-03-14 |