| 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 |