| NPI | 1407075294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 222713) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: MA 222713) |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: MA 222713) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2015-07-15 |