| NPI | 1356481790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: ID M7357) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: ID M7357) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: ID M7357) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2012-06-20 |