| NPI | 1548363468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A068915) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CA A068915) |
| 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: CA A068915) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2021-04-19 |