| NPI | 1467456897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX E5353) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: TX E5353) |
| 208D00000X General Practice (Licence: TX E5353) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2015-01-27 |