| NPI | 1417902552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 9401309) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 9401309) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NC 9401309) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2014-01-02 |