| NPI | 1508955071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: GA 012470) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: GA 12470) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-09-08 |