| NPI | 1548218555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: AZ 37977) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VT 042.0012187) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: VT 042.0012187) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-01-13 |