| NPI | 1487739579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 39460) |
| 207R00000X Internal Medicine (Licence: NC 39460) | |
| 2084P0005X Psychiatry & Neurology, Neurodevelopmental Disabilities (Licence: NC 39460) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 39460) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2017-04-19 |