| NPI | 1477517191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 4301048493) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: MI 4301048493) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2022-11-23 |