| NPI | 1558379263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MS 13970) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: MS 13970) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2012-11-02 |