| NPI | 1366409823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 32668-020) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: WI 32668) |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: WI 32668-020) | |
| 2084F0202X Psychiatry & Neurology Forensic Psychiatry (Licence: WI 32668-020) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2007-12-14 |