| NPI | 1417161803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LA0401X Anesthesiology Addiction Medicine (Licence: NH 9025) |
| Additional Taxonomies | 2084P0015X Psychiatry & Neurology Psychosomatic Medicine (Licence: NH 9025) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-07-08 |