| NPI | 1427048776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KY 25687) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: KY 25687) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2014-12-09 |