NPI | 1366651150 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA 37768) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 37768) |
2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: IA 37768) | |
Enumeration Date | 2007-05-21 |
Last Update Date | 2017-02-14 |