| NPI | 1558510453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: GA 30026) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 34262) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2021-12-22 |