| NPI | 1396730123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: MA 155325) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 155325) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2017-02-15 |