| NPI | 1366523557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MI 4301503780) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: PA MD442927) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-06-14 |