NPI | 1427154038 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: CA A85105) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A85105) |
207RA0401X Internal Medicine Addiction Medicine (Licence: CA A85105) | |
208VP0000X Pain Medicine Pain Medicine (Licence: CA A85105) | |
Enumeration Date | 2006-09-15 |
Last Update Date | 2015-01-18 |