| NPI | 1467433060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD065361L) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: PA MD065361L) |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: PA MD065361L) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2022-03-15 |