| NPI | 1487709200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 39227) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: WI 39227) |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: WI 39227) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2021-12-03 |