| NPI | 1548203425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: PA MD011165E) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL ME123861) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MD D0053139) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2019-05-16 |